HIV Disease Progression

Inflammatory changes and damage to the gut begin very soon after initial HIV infection, and may not return to normal even when people start antiretroviral therapy (ART) very early, researchers reported at the recent 2015 Conference on Retroviruses and Opportunistic Infections (CROI) in Seattle. Biomarkers of inflammation, coagulation and fibrosis increased early on, and while they generally decreased after starting ART, they did not fall to levels seen in HIV-negative people.

A study from Cuba, recently published online in EBioMedicine, has generated wide media interest because researchers have identified a particular variety of the virus, dubbed CRF19_cpx, that is associated with rapid post-diagnosis drops in CD4 T-cell count and progression to AIDS. In the study, all of the still relatively small minority of people with this viral variant progressed to clinically defined AIDS within 3 years of infection. The variant also seems to be becoming more common in Cuba and may partly explain what appears to be an increase in the proportion of people who progress rapidly to AIDS. However, it is not a drug-resistant strain and antiretroviral therapy (ART) works just as well against it as it does against any other strain of HIV.

Smoking doubles the mortality risk for people with HIV taking antiretroviral therapy, a study published recently in AIDS shows. Smokers had an increased risk of death from cardiovascular disease (CVD) and non-AIDS-related cancers, and the life expectancy of a 35-year-old man with HIV was reduced by almost 8 years due to smoking.

Elite controllers -- people who naturally maintain viral suppressed without antiretroviral treatment -- had higher rates of hospitalization than people with HIV on antiretroviral therapy, most commonly for cardiovascular conditions, researchers reported in the December 15 Journal of Infectious Diseases. A related study showed that B cell follicles may act as a reservoir for an HIV-like virus in elite controller monkeys.

The largest cohort study ever to look at CD4 count and viral loads in HIV positive people around the time of diagnosis has found evidence that HIV -- at least in Europe -- has become more virulent over time. The average time taken to reach a CD4 count below 350 cells/mm3 has halved over the last 25 years, researchers calculate. This conflicts with recently reported findings from Africa suggesting HIV has gotten weaker, suggesting that local conditions may drive viral evolution in opposite directions.